ORIGINAL STUDY Correction of Chronic Lunotriquetral Instability Using Extensor Retinacular Split

Total Page:16

File Type:pdf, Size:1020Kb

ORIGINAL STUDY Correction of Chronic Lunotriquetral Instability Using Extensor Retinacular Split Acta Orthop. Belg., 2007, 73, 451-457 ORIGINAL STUDY Correction of chronic lunotriquetral instability using extensor retinacular split : A retrospective study of 26 patients Ilkka ANTTI-POIKA, Jukka HYRKÄS, Liisa M VIRKKI, Daisuke OGINO, Yrjö T KONTTINEN From the Orto-Lääkärit Medical Center, Helsinki, Finland, Helsinki University Central Hospital, Helsinki, Finland, the ORTON Orthopaedic Hospital of the Invalid Foundation, Helsinki, Finland, and the COXA Hospital for the Joint Replacement, Tampere, Finland Arthroscopy offers a welcome and reliable supple- INTRODUCTION ment to the current tool set for the diagnosis of lunotriquetral (LT) instability. This study reports the Lunotriquetral (LT) instability may occur as an findings of LT-lesions during arthroscopy and the isolated ligamentous injury of the LT-joint (7) or, clinical results obtained after using dorsal stabilisa- probably in most cases, together with some other tion in its surgical management using extensor reti- injuries of the ulnar side of the wrist. It causes rest nacular split. LT-instability of grade I-III was diag- pain and mostly activity-induced pain in grip nosed in 26 patients. Imaging results were normal, activities, and leads to giving away sensations. The Reagan’s ballottement and Watson tests were posi- diagnosis of lunotriquetral instability is based part- tive in 47% and 79%, respectively. After arthroscop- ly on the patient history and the injury mechanism, ic diagnosis, the procedure was immediately contin- ued with an open repair utilising an 8-10 mm wide and radial-based extensor retinacular split for dorsal capsular reinforcement. At 39 months (range : 14 to ■ Ilkka Antti-Poika, MD, PhD, Senior Hand Surgeon. 84) follow-up, 64% had no or only occasional mild ■ Jukka Hyrkäs, MD, Senior Hand Surgeon. pain and 36% had pain with overuse or lifting. Orto-Lääkärit Medical Center, Helsinki, Finland. Overall scoring encompassing pain, patient satisfac- ■ Daisuke Ogino, PhD, Post doctoral Fellow. tion, range of motion and grip strength, was excellent Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland. in 24% and good in 64%. Only three patients had ■ Liisa M Virkki, MSc, PhD Student. fair results, one after a further injury leading to dis- Department of Medicine, Helsinki University Central tal radio-ulnar joint (DRUJ) instability, and two with Hospital, Helsinki, Finland and ORTON Orthopaedic Hospital concurrent DRUJ-stabilisation. One further patient of the Invalid Foundation, Helsinki, Finland. required a secondary procedure. Arthroscopy seems ■ Yrjö T Konttinen, MD, PhD, Professor. to allow accurate diagnosis of LT-instability and can Department of Medicine, Helsinki University Central be continued in the same session using a straight- Hospital, Helsinki, Finland, ORTON Orthopaedic Hospital of the Invalid Foundation, Helsinki, Finland and COXA Hospital forward reconstruction procedure providing satis- for the Joint Replacement, Tampere, Finland. factory results. Correspondence : Ilkka Antti-Poika, Orto-Lääkärit Medical Keywords : wrist ; lunotriquetral instability ; extensor Center, Yrjönkatu 36 A, 00100 Helsinki, Finland. E-mail : [email protected]. retinacular split. © 2007, Acta Orthopædica Belgica. No benefits or funds were received in support of this study Acta Orthopædica Belgica, Vol. 73 - 4 - 2007 452 I. ANTTI-POIKA, J. HYRKÄS, L. M. VIRKKI, D. OGINO, Y. T. KONTTINEN which are often difficult to recall, and proper diag- lunotriquetral instability, two were lost to follow-up, and nosis and treatment are therefore delayed (9). the outcomes were evaluated for 26 patients. During the past 20 years, the cornerstones of the The mean age of the patients at the time of the oper- correct diagnosis of LT instability have been pain ation was 35 years (range : 14 to 54). Sixty two percent and tenderness over the LT-joint and a positive (n = 16) of the patients were women. The occupations of the patients were as follows : lunotriquetral ballottement test (7). Radiographs may show slight narrowing and cystic changes on Office, sales, management 10 (38%) both sides of the LT-joint, computerised tomogra- Student 5 (19%) phy can further depict the bony structures of the Healthcare, childcare, education 4 (15%) LT-joint, but more recently MRI and especially Industrial 2 (8%) arthroscopy of the radiocarpal and midcarpal joint Transportation 2 (8%) Agricultural 1 (4%) have revolutionised the diagnostics (2). Sports, physical education 1 (4%) Magnetic resonance imaging provides informa- Unknown 1 (4%) tion on the status of the extrinsic and intrinsic ligaments and joint capsule, but it does not allow The injury mechanisms were a fall on the hand in testing of the instability of the LT-joint. Therefore, 10 patients (38%), trauma without falling in 11 patients (42%), no acute trauma in 3 patients (12%) and a seque- arthroscopy offers a welcome and most reliable lae of radial fracture in 2 patients (8%). Of those who supplement to the current diagnostic tool set. fell, six did so when walking or performing some other During normal arthroscopic examination the LT- daily activity, such as walking in stairs, and three when joint is viewed on both radiocarpal and midcarpal performing sports or some equivalent physical activity sides, which allows exact visualisation of the (cycling, rollerblading and football). One further patient location and type of the damage. After arthroscopy fell two meters from a ladder. Of the traumas not involv- has confirmed the diagnosis of lunotriquetral ing a fall, five were related with sports (volleyball, ice instability, specific site-directed treatment can be hockey, floor hockey, tennis and acrobatics), three provided during the same anaesthesia by convert- involved other activities (usage of tools in two and lift- ing the diagnostic arthroscopy to an operative ing injury in one) and three were twisting injuries with- procedure. This is very relevant as the diagnosis by out detailed history. The traumas by falling or without itself is not the goal but is only a means for plan- falling involved twisting, hyperextension or supination injuries of the wrists. In addition, two traumas with a fall ning an injury-type specific treatment. We used this involved a radius fracture. option and developed a new operative modification The right wrist was injured in 14 of the patients for stabilisation of lunotriquetral instability. This is (54%) and the left in 12 (46%). Twelve patients injured particularly important because many of these their dominant hand, and twelve injured their non-dom- patients are young and physically active and, there- inant hand. For two patients the information of handed- fore, incapacitated in their hobbies, mostly sports. ness was missing. The mean time from injury to opera- This study reports the findings of lunotriquetral tion was 19 months (range : 1 to 120). lesions during arthroscopy and the clinical results obtained after dorsal stabilisation using extensor Clinical tests retinacular split. Clinical tests Preoperative lunotriquetral ballottement test results PATIENTS AND METHODS were available for 17 patients, of which 8 (47%) had a positive and 9 (53%) a negative result. Of the 19 patients Patient demographics and injury mechanisms with available information on the preoperative Watson test, 15 (79%) had a positive result and 4 (21%) had a The first author performed 28 lunotriquetral stabilisa- negative result. All those fifteen patients (58%), who tion operations on consecutive patients from 1998 to were tested using midcarpal provocation test, had a neg- 2003 using the technique described below. Of the ative test result ; 11 (42%) patients had not been tested 28 patients who had undergone stabilisation surgery for using this test. Acta Orthopædica Belgica, Vol. 73 - 4 - 2007 CORRECTION OF CHRONIC LUNOTRIQUETRAL INSTABILITY 453 Arthroscopy Wrist arthroscopy was performed using five routine portals of which three had a radiocarpal location and two a midcarpal location. Finger traction was usually applied to the second and fourth fingers using 3-6 kgf, depend- ing on the weight of the patient. Counter-traction was T applied to the upper arm. L Arthroscopy was performed in operation room facili- ERS ties under general anaesthesia and using a tourniquet. If lunotriquetral instability was diagnosed in arthroscopy, ER the operation described below was performed in an open manner with the patient’s arm lying on the table and without counter-traction. Lunotriquetral stabilisation A dorsal operative approach was used. A lazy S- or Z- type skin incision was performed depending on the arthroscopic portals used. The extensor retinaculum was Fig. 1. — Lunotriquetral stabilisation using a dorsal operative exposed and depending on its width and strength, an 8- approach. Extensor retinaculum is exposed and depending 10 mm wide and radial-based strip was harvested distal- on its used width and strength, an 8-10 mm wide and radial- ly from the extensor retinaculum (fig 1). The dorsal sur- based split (ERS)is harvested distally from the extensor faces of both lunatum and triquetrum were exposed by retinaculum (ER). dividing the capsule obliquely. A fixing anchor (Mitek mini anchor, DePuy Mitek Inc., Norwood, MA, or Arthrex Small Bone FasTak titanium anchor, Arthrex Inc., Naples, FL) was inserted into both bones (fig 2). With the wrist in a neutral position in flexion-extension, ERS the strip was turned over the lunotriquetral joint and fixed to the anchor threads with proper tension.
Recommended publications
  • Procedure Code List Effective Jan. 1, 2020 for Preauthorization for Blue Cross and Blue Shield of New Mexico Medicare Advantage Members Only
    Procedure Code List Effective Jan. 1, 2020 for Preauthorization for Blue Cross and Blue Shield of New Mexico Medicare Advantage Members only Beginning Jan. 1, 2020, providers will be required to obtain preauthorization through Blue Cross and Blue Shield of New Mexico (BCBSNM), Optum, or eviCore for certain procedures for Blue Cross Medicare Advantage members as noted in the MAPD Benefit Preauthorization Procedure Code List, Effective 1/1/2020, below. For members NOT attributed to Optum, preauthorization should be obtained from BCBSNM unless the applicable entry in the MAPD Benefit Preauthorization Procedure Code List references eviCore. For members attributed to Optum, preauthorization should be obtained from Optum, even if the applicable entry in the MAPD Benefit Preauthorization Procedure Code List references eviCore. Any entry that references eviCore should be preauthorized through eviCore except for members attributed to Optum. The member's ID Card will indicate that the member is attributed to Optum. Services performed without benefit preauthorization may be denied for payment in whole or in part, and you may not seek reimbursement from members. Member eligibility and benefits should be checked prior to every scheduled appointment. Eligibility and benefit quotes include membership status, coverage status and other important information, such as applicable copayment, coinsurance and deductible amounts. It is strongly recommended that providers ask to see the member's ID card for current information and a photo ID to guard against medical identity theft. A referral to an out-of-plan or out-of-network provider which is necessary due to network inadequacy or continuity of care must be reviewed by the BCBSNM Utilization Management or DMG (if the member is attributed to DMG this information will be reflected on the ID card) prior to a BCBSNM patient receiving care.
    [Show full text]
  • Carpal-Instability-Slide-Summary.Pdf
    Carpal Instabilities Definition by IFSSH Orthopaedic Hand Conference Wrist is unstable only if it exhibits • symptomatic dysfunction Bernard F. Hearon, M.D. inability to bear loads Clinical Assistant Professor, Department of Surgery • University of Kansas School of Medicine - Wichita May 7, 2019 • abnormal carpal kinematics Garcia-Elias, JHS 1999 Carpal Instability Mayo Classification CID - Dissociative Wright, JHS (Br) 1994 Instability within carpal row usually due to intrinsic ligament injury • Carpal Instability Dissociative (CID) • Carpal Instability Non-Dissociative (CIND) • Scapholunate dissociation • Carpal Instability Adaptive (CIA) • Lunotriquetral dissociation • Carpal Instability Complex (CIC) • Scaphoid fracture Carpal Instability Carpal Instability CIND - Nondissociative Instability between carpal rows due CIA - Adaptive to extrinsic ligament injury Extra-carpal derangement causing carpal malalignment • CIND - Volar Intercalated Segment Instability (VISI) Midcarpal instability caused by malunited • CIND - Dorsal Intercalated fractures of the distal radius Segment Instability (DISI) Taleisnik, JHS 1984 • Combined CIND Carpal Instability Carpal Instability CIC - Complex Instability patterns with qualities of both CID and CIND patterns • Dorsal perilunate dislocations (lesser arc) Perilunate • Dorsal perilunate fracture-dislocations (greater arc injuries) Instability • Volar perilunate dislocations • Axial dislocations, fracture-dislocations Carpal Instability Carpal Instability Perilunate Dislocations Mayfield Classification Progressive
    [Show full text]
  • Disorders of the Knee
    DisordersDisorders ofof thethe KneeKnee PainPain Swelling,Swelling, effusioneffusion oror hemarthrosishemarthrosis LimitedLimited jointjoint motionmotion Screw home mechanism – pain, stiffness, fluid, muscular weakness, locking InstabilityInstability – giving way, laxity DeformityDeformity References: 1. Canale ST. Campbell’s operative orthopaedics. 10th edition 2003 Mosby, Inc. 2. Netter FH. The Netter collection of Medical illustrations – musculoskeletal system, Part I & II. 1997 Novartis Pharmaceuticals Corporation. 3. Magee DJ. Orthopedic Physical assessment. 2nd edition 1992 W. B. Saunders Company. 4. Hoppenfeld S. Physical examination of the spine and extremities. 1976 Appleton-century-crofts. AnteriorAnterior CruciateCruciate LigamentLigament Tibial insertion – broad, irregular, diamond-shaped area located directly in front of the intercondylar eminence Femoral attachment Femoral attachment Figure 43-24 In addition to their – semicircular area on the posteromedial synergistic functions, cruciate aspect of the lateral condyle and collateral ligaments exercise 33 mm in length basic antagonistic function 11 mm in diameter during rotation. A, In external Anteromedial bundle — tight in flexion rotation it is collateral ligaments that tighten and inhibit excessive Posterolateral bundle — tight in extension rotation by becoming crossed in 90% type I collagen space. B, In neutral rotation none 10% type III collagen of the four ligaments is under unusual tension. C, In internal Middle geniculate artery rotation collateral ligaments Fat
    [Show full text]
  • Analysis of Rehabilitation Procedure Following Arthroplasty of the Knee with the Use of Complete Endoprosthesis
    © Med Sci Monit, 2011; 17(3): CR165-168 WWW.MEDSCIMONIT.COM PMID: 21358604 Clinical Research CR Received: 2010.10.01 Accepted: 2010.12.23 Analysis of rehabilitation procedure following Published: 2011.03.01 arthroplasty of the knee with the use of complete endoprosthesis Authors’ Contribution: Magdalena Wilk-Frańczuk¹,²ACDEF, Wiesław Tomaszewski3ACDEF, Jerzy Zemła²ABDEF, A Study Design Henryk Noga4DEF, Andrzej Czamara3ADEF B Data Collection C Statistical Analysis 1 Andrzej Frycz Modrzewski Cracow University, Cracow, Poland D Data Interpretation 2 Cracow Rehabilitation Centre, Cracow, Poland E Manuscript Preparation 3 College of Physiotherapy, Wroclaw, Poland F Literature Search 4 Endoscopic Surgery Clinic and Sport Clinic Żory, Żory, Poland G Funds Collection Source of support: Departmental sources Summary Background: The use of endoprosthesis in arthroplasty requires adaptation of rehabilitation procedures in or- der to reinstate the correct model of gait, which enables the patient to recover independence and full functionality in everyday life, which in turn results in an improvement in the quality of life. Material/Methods: We studied 33 patients following an initial total arthroplasty of the knee involving endoprosthesis. The patients were divided into two groups according to age. The range of movement within the knee joints was measured for all patients, along with muscle strength and the subjective sensation of pain on a VAS, and the time required to complete the ‘up and go’ test was measured. The gait model and movement ability were evaluated. The testing was conducted at baseline and after com- pletion of the rehabilitation exercise cycle. Results: No significant differences were noted between the groups in the tests of the range of movement in the operated joint or muscle strength acting on the knee joint.
    [Show full text]
  • Subtalar Joint Version 1.0 Effective June 15, 2021
    CLINICAL GUIDELINES CMM-407: Arthroscopy: Subtalar Joint Version 1.0 Effective June 15, 2021 Clinical guidelines for medical necessity review of Comprehensive Musculoskeletal Management Services. © 2021 eviCore healthcare. All rights reserved. Comprehensive Musculoskeletal Management Guidelines V1.0 CMM-407: Arthroscopy: Subtalar Joint Definitions 3 General Guidelines 3 Indications 4 Non-Indications 5 Procedure (CPT®) Codes 5 References 6 ______________________________________________________________________________________________________ ©2021 eviCore healthcare. All Rights Reserved. Page 2 of 6 400 Buckwalter Place Boulevard, Bluffton, SC 29910 (800) 918-8924 www.eviCore.com Comprehensive Musculoskeletal Management Guidelines V1.0 Definitions Red flags indicate comorbidities that require urgent/emergent diagnostic imaging and/or referral for definitive therapy. Clinically meaningful improvement is defined as at least 50% improvement noted on global assessment. General Guidelines Either of the following are considered red flag conditions for subtalar joint arthroscopy: Post-reduction evaluation and management of the subtalar dislocation Septic arthritis in the subtalar joint Although imaging may be normal, prior to subtalar joint arthroscopy, radiographic imaging should be performed and include both of the following: Plain X-rays with one or more views (anteroposterior, lateral, axial, and/or Broden’s) to confirm and differentiate any of the following: Degenerative joint changes Loose bodies Osteochondral lesions Impingement
    [Show full text]
  • PT/OT Therapy Intake Form Required for All MSK Conditions (Including Hand) Please Use This Fax Form for NON-URGENT Requests Only
    Musculoskeletal Program: PT/OT Therapy Intake Form Required for all MSK Conditions (Including Hand) Please use this fax form for NON-URGENT requests only. Failure to provide all relevant information may delay the determination. Phone and fax numbers may be found on eviCore.com under the Guidelines and Forms section. You may also log into the provider portal located on the site to submit an authorization request. URGENT (same day) REQUESTS MUST BE SUBMITTED BY PHONE Previous Reference/Auth Number (If Continued Care): Date of Submission: Place of Service: ****** Note: This is REQUIRED for WellCare Submissions ******* Service Type Requested: Physical Therapy Occupational Therapy First Name: MI: Last Name: Member ID: DOB (mm/dd/yyyy): Gender: Male Female Street Address: Apt #: City: State: Zip: PATIENT Home Phone: Cell Phone: Primary: Home Cell Member Health Plan/Insurer: First Name: Last Name: Primary Specialty: TIN: NPI: Physician Phone: Physician Fax: Address: Suite #: City: State: Zip: PROVIDER Office Contact: Ext: Email: Diagnoses: Code Description Code Description Start Date for this Request: This is a (select the most appropriate): New condition not previously treated Same/previous condition Date of initial evaluation: Date of onset of condition: Date of current findings: Primary Treatment Area: Spine: Cervical / Upper Thoracic Lower Thoracic / Lumbar / Pelvis Upper Extremity: Shoulder / Arm Elbow / Wrist / Forearm Hand Lower Extremity: Hip / Thigh Knee Ankle / Foot Other: Pelvic Pain / Incontinence Secondary Treatment Area: Spine:
    [Show full text]
  • In Patients with End-Stage Ankle Arthritis, How Does Total Ankle Arthroplasty Compared to Arthrodesis Affect Ankle Pain and Function?
    University of the Pacific Scholarly Commons Physician's Assistant Program Capstones School of Health Sciences 4-1-2020 In Patients with End-Stage Ankle Arthritis, How Does Total Ankle Arthroplasty Compared to Arthrodesis Affect Ankle Pain and Function? Zachary Whipple University of the Pacific, [email protected] Follow this and additional works at: https://scholarlycommons.pacific.edu/pa-capstones Part of the Medicine and Health Sciences Commons Recommended Citation Whipple, Zachary, "In Patients with End-Stage Ankle Arthritis, How Does Total Ankle Arthroplasty Compared to Arthrodesis Affect Ankle Pain and Function?" (2020). Physician's Assistant Program Capstones. 84. https://scholarlycommons.pacific.edu/pa-capstones/84 This Capstone is brought to you for free and open access by the School of Health Sciences at Scholarly Commons. It has been accepted for inclusion in Physician's Assistant Program Capstones by an authorized administrator of Scholarly Commons. For more information, please contact [email protected]. In Patients with End-Stage Ankle Arthritis, How Does Total Ankle Arthroplasty Compared to Arthrodesis Affect Ankle Pain and Function? By Zachary Whipple Capstone Project Submitted to the Faculty of the Department of Physician Assistant Education of the University of the Pacific in partial fulfilment of the requirements for the degree of MASTER OF PHYSICIAN ASSISTANT STUDIES April 2020 Introduction End-stage ankle arthritis is a debilitating degenerative disease commonly located at the tibiotalar joint. The prevalence of symptomatic arthritis is about nine times lower than the rates associated with those of the knee or hip.1 Though less common than knee and hip arthritis, the US estimates greater than 50,000 new cases are reported each year.2 The most common etiology of ankle arthritis is post-traumatic pathology.
    [Show full text]
  • MAP Preauthorization List EFF: 8/1/2017 (Updated 8/24/17)
    MAP Preauthorization List EFF: 8/1/2017 (Updated 8/24/17) CPT, HCPCS Description Comment or Revenue Code Revenue Codes 0100 All inclusive room and board plus ancillary 0101 All inclusive room and board 0110 Room and Board Private (one bed) 0111 Room and Board Private (one bed) - Medical/Surgical/GYN 0113 Room and Board Private (one bed) - Pediatric 0117 Room and Board Private (one bed) - Oncology 0118 Room and Board Private (one bed) - Rehab 0119 Room and Board Private (one bed) - Other 0121 Room and Board Semiprivate (two beds) - Medical/Surgical/GYN 0123 Room and Board Semiprivate (two beds) - Pediatric 0127 Room and Board Semiprivate (two beds) - Oncology 0128 Level 1 Rehab 0129 Level 2 Rehab - acute complex 0130 Room & Board - Three and Four Beds General Classification 0131 Room & Board - Three and Four Beds Medical/Surgical/Gyn 0133 Room & Board - Three and Four Beds Pediatric 0137 Room & Board - Three and Four Beds Oncology 0138 Room & Board - Three and Four Beds Rehabilitation 0139 Room & Board - Three and Four Beds Other 0140 Room & Board - Deluxe Private General Classification 0141 Room & Board - Deluxe Private Medical/Surgical/Gyn 0143 Room & Board - Deluxe Private Pediatric 0147 Room & Board - Deluxe Private Oncology 0148 Room & Board - Deluxe Private Rehabilitation 0149 Room & Board - Deluxe Private Other 0150 Room & Board - Ward General Classification 0151 Room & Board - Ward Medical/Surgical/Gyn 0153 Room & Board - Ward Pediatric 0157 Room & Board - Ward Oncology 0158 Room & Board - Ward Rehabilitation 0159 Room & Board -
    [Show full text]
  • 114.3 Cmr: Division of Health Care Finance and Policy Ambulatory Care
    114.3 CMR: DIVISION OF HEALTH CARE FINANCE AND POLICY AMBULATORY CARE 114.3 CMR 40.00: RATES FOR SERVICES UNDER M.G.L. c. 152, WORKERS’ COMPENSATION ACT Section 40.01: General Provisions 40.02: General Definitions 40.03: Service and Rate Coverage Provisions 40.04: Provisions Affecting Eligible Providers 40.05: Policies for Individual Service Types 40.06: Fees 40.07: Appendices 40.08: Severability 40.01: General Provisions (1) Scope, Purpose and Effective Date. 114.3 CMR 40.00 governs the payment rates effective April 1, 2009 for purchasers of health care services under M.G.L. c. 152, the Workers’ Compensation Act. Payment rates for services provided by hospitals are set forth in 114.1 CMR 41.00. Program policies relating to medical necessity and clinical appropriateness are determined pursuant to M.G.L. c. 152 and 452 CMR 6.00. (2) Coverage. The payment rates set forth in 114.3 CMR 40.06 are full payment for services provided under M.G.L. c. 152, § 13, including any related administrative or overhead costs. The insurer, employer and health care service provider may agree upon a different payment rate for any service set forth in the fee schedule in 114.3 CMR 40.00. No employee may be held liable for the payment for health care services determined compensable under M.G.L. c. 152, § 13. (3) Administrative Bulletins. The Division may issue administrative bulletins to clarify substantive provisions of 114.3 CMR 40.00, or to publish procedure code updates and corrections. For coding updates and correction, the bulletin will list: (a) new code numbers for existing codes, with the corresponding cross references between existing and new codes numbers; (b) deleted codes for which there are no corresponding new codes; and (c) codes for entirely new services that require pricing.
    [Show full text]
  • Knee Pain in Children: Part I: Evaluation
    Knee Pain in Children: Part I: Evaluation Michael Wolf, MD* *Pediatrics and Orthopedic Surgery, St Christopher’s Hospital for Children, Philadelphia, PA. Practice Gap Clinicians who evaluate knee pain must understand how the history and physical examination findings direct the diagnostic process and subsequent management. Objectives After reading this article, the reader should be able to: 1. Obtain an appropriate history and perform a thorough physical examination of a patient presenting with knee pain. 2. Employ an algorithm based on history and physical findings to direct further evaluation and management. HISTORY Obtaining a thorough patient history is crucial in identifying the cause of knee pain in a child (Table). For example, a history of significant swelling without trauma suggests bacterial infection, inflammatory conditions, or less likely, intra- articular derangement. A history of swelling after trauma is concerning for potential intra-articular derangement. A report of warmth or erythema merits consideration of bacterial in- fection or inflammatory conditions, and mechanical symptoms (eg, lock- ing, catching, instability) should prompt consideration of intra-articular derangement. Nighttime pain and systemic symptoms (eg, fever, sweats, night sweats, anorexia, malaise, fatigue, weight loss) are associated with bacterial infections, inflammatory conditions, benign and malignant musculoskeletal tumors, and other systemic malignancies. A history of rash or known systemic inflammatory conditions, such as systemic lupus erythematosus or inflammatory bowel disease, should raise suspicion for inflammatory arthritis. Ascertaining the location of the pain also can aid in determining the cause of knee pain. Anterior pain suggests patellofemoral syndrome or instability, quad- riceps or patellar tendinopathy, prepatellar bursitis, or apophysitis (patellar or tibial tubercle).
    [Show full text]
  • Artificial Finger Joint Replacement Due to a Giant Cell Tumor of the Tendon Sheath with Bone Destruction: a Case Report
    3502 ONCOLOGY LETTERS 10: 3502-3504, 2015 Artificial finger joint replacement due to a giant cell tumor of the tendon sheath with bone destruction: A case report HUI LU, HUI SHEN, QIANG CHEN, XIANG-QIAN SHEN and SHOU-CHENG WU Department of Hand Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China Received October 24, 2014; Accepted September 25, 2015 DOI: 10.3892/ol.2015.3813 Abstract. The current study presents the case of a 25-year-old excised completely and the function of the joints was recov- male who developed tumor recurrence of the proximal ered. phalange of the ring finger on the right hand 4 years after partial tumor resection surgery. An X-ray of the right hand Case report showed that the distal bone of the proximal phalange on the ring finger was destroyed. An artificial finger joint replace- A 25-year-old male was admitted to The First Affiliated ment was performed using a silicone joint for this unusual Hospital, College of Meicine, ZheJiang University (Hangzhou, tumor recurrence. The pathological findings were indicative of Zhejiang, China) with tumor recurrence of the proximal a giant cell tumor of the tendon sheath. As a result of surgery, phalange of the ring finger on the right hand 4 years after the patient's proximal interphalangeal point motion recovered partial tumor resection surgery. The patient had no history to the pre-operative level. The pre-operative and post-operative of trauma or infection and was previously healthy. A physical disabilities of the arm, at shoulder and hand and total activity examination revealed swelling of the proximal phalange of the measurement values were 1.67 and 3.33, and 255 and 243˚, finger without clear cause, multiple nodules in the local areas respectively.
    [Show full text]
  • Differences Between Subtotal Corpectomy and Laminoplasty for Cervical Spondylotic Myelopathy
    Spinal Cord (2010) 48, 214–220 & 2010 International Spinal Cord Society All rights reserved 1362-4393/10 $32.00 www.nature.com/sc ORIGINAL ARTICLE Differences between subtotal corpectomy and laminoplasty for cervical spondylotic myelopathy S Shibuya1, S Komatsubara1, S Oka2, Y Kanda1, N Arima1 and T Yamamoto1 1Department of Orthopaedic Surgery, School of Medicine, Kagawa University, Kagawa, Japan and 2Oka Orthopaedic and Rehabilitation Clinic, Kagawa, Japan Objective: This study aimed to obtain guidelines for choosing between subtotal corpectomy (SC) and laminoplasty (LP) by analysing the surgical outcomes, radiological changes and problems associated with each surgical modality. Study Design: A retrospective analysis of two interventional case series. Setting: Department of Orthopaedic Surgery, Kagawa University, Japan. Methods: Subjects comprised 34 patients who underwent SC and 49 patients who underwent LP. SC was performed by high-speed drilling to remove vertebral bodies. Autologous strut bone grafting was used. LP was performed as an expansive open-door LP. The level of decompression was from C3 to C7. Clinical evaluations included recovery rate (RR), frequency of C5 root palsy after surgery, re-operation and axial pain. Radiographic assessments included sagittal cervical alignment and bone union. Results: Comparisons between the two groups showed no significant differences in age at surgery, preoperative factors, RR and frequency of C5 palsy. Progression of kyphotic changes, operation time and volumes of blood loss and blood transfusion were significantly greater in the SC (two- or three- level) group. Six patients in the SC group required additional surgery because of pseudoarthrosis, and four patients underwent re-operation because of adjacent level disc degeneration.
    [Show full text]